Palliative Care End of Life and More. Palliative care aims to relieve suffering and improve the quality of living and dying. Palliative is from the Greek word “to cloak”. Palliative Care: Some Definitions
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End of Life and More
Palliative care aims to relieve suffering and improve the quality of living and dying.
Palliative is from the Greek word “to cloak”
Myths and Misconceptions in the course of illness, in conjunction with anti (cancer) treatment. (WHO, 1990)
Palliative care is end-of-life care only
Palliative care is doing nothing
Palliative care starts when curative treatment stops
Palliative care is new-age “kumbayah”
Myths and in the course of illness, in conjunction with anti (cancer) treatment. (WHO, 1990)Misconceptions
Palliative care means that medical care has failed
Palliative care is a nice but not necessary addition to health care
Palliative care can only be implemented by physicians and nurses with specialty credentials
Center to Advance Palliative Care 2000
Center to Advance Palliative Care 2000
Palliative care is most effectively delivered by an interdisciplinary team.
Palliative care may complement and enhance disease-modifying therapy, or it may become the total focus of care.
Palliative care may also be applicable to patients and families experiencing acute illness and/or chronic illness.
Distinction: Palliative Care and Hospice interdisciplinary team.
Palliative care addresses the physical, psychosocial, and spiritual needs and expectations of patients with acute or chronic illness at any time during that illness—even if life expectancies extend to years.
Hospice care is a palliative care “package”provided to patients who have a life expectancy of less than 6 months if the disease runs its usual course, in the judgment of the patient's attending physician and the hospice medical director. Medical intervention is limited.
Modern health care
< 10%, MI, accident, etc
Steady Decline, Short Terminal Phase interdisciplinary team.
Slow Decline, Periodic Crises, Sudden Death interdisciplinary team.
CHF, emphysema, Alzheimer’s-type dementia
The Cure - Care Model: interdisciplinary team. The old system
Life Prolonging Care
Palliative Care’s Place in the Course of Illness interdisciplinary team.
Life Prolonging Therapy
Diagnosis of serious illness
Medicare Hospice Benefit
Common Issues interdisciplinary team.
Last Acts Report Card, Texas Specific Data interdisciplinary team.
Death in the hospital: interdisciplinary team. What do we know about it?
National data on the experience of dying in 5 tertiary care teaching hospitals
The SUPPORT Study
SUPPORT: Phase I Results teaching hospitals
Pain data from SUPPORT teaching hospitals
% of 5176 patients reporting moderate to severe pain between days 8-12 of hospitalization:
colon cancer 60%
liver failure 60%
lung cancer 57%
MOSF + cancer 53%
MOSF + sepsis 52%
Desbiens & Wu. JAGS 2000;48:S183-186.
CPR Data teaching hospitals
MISSION teaching hospitals
The mission of The Methodist Hospital’s Pain and Palliative Care at Program and Supportive Care Consultation Service is to enhance the quality of life for patients and their families by the prevention and relief of suffering, through attention to physical, emotional, social, and spiritual concerns associated with illness or injury.
Goals of Palliative Care at TMH teaching hospitals
Palliative Care at The Methodist Hospital emotional, and psychosocial comfort of patients and families
Edmonton Symptom Assessment Scale (ESAS Numerical Scale) emotional, and psychosocial comfort of patients and families
Please circle the number that best describes:
No Pain 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Pain
Not Tired 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Tiredness
Not Nauseated 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Nausea
Not Depressed 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Depression
Not Anxious 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Anxiety
Not Drowsy 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Drowsiness
Best Appetite 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Appetite
Best Feeling of Well being 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Feeling
No Shortness of Breath 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Shortness of Breath
Other Problem 0 1 2 3 4 5 6 7 8 9 10
A Palliative Care Story emotional, and psychosocial comfort of patients and families
Patient Mrs. K 50 years old
126 days in the hospital
CA and multiple medical problems
Severe neuropathic pain from herpetic lesions in groin
High-dose opioids causing problems, but no relief
Liver problems/jaundice from TPN
Feculent vomiting, hasn’t eaten in weeks
Physicians said “there’s nothing more we can do”
Palliative Care Consultation for Mrs. K emotional, and psychosocial comfort of patients and families
Spending as much time as necessary to find out who she is and what she wants
Rigorous symptom and pain assessment
“Moving mountains” to get IV methadone
Symptom (nausea/vomiting) management
Withdrawing unnecessary/unwanted treatment
Relief from nausea/vomiting
From NPO to clear liquids to fried chicken in just a few days
Went to hospital beauty parlor for to have hair done
Discharged after 141 days in hospital
Died peacefully at home ten days after discharge
There is never “nothing more we can do”. emotional, and psychosocial comfort of patients and families
“You matter because you are you. You matter to the last moment of your life, and we will do all we can not only to help you die peacefully, but to help you live until you die.”
Cicely Saunders, RN, SW, MD
Founder, Modern Hospice Movement